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ESTRO 35 2016 S557

________________________________________________________________________________

analysis showed no relationship between cosmetic result and

age (p>0.13).

Conclusion:

Our experiences is limited to a low number of

cases but confirm that adjuvant radiotherapy is not

controindicated when reconstructive surgery is expected. The

patient must be informed about the possible radiation

sequelae.

EP-1168

Phase II trial of hypofractionated VMAT treatment for early

stage breast cancer: 2-years outcomes

F. De Rose

1

Istituto Clinico Humanitas, Radiotherapy and Radiosurgery,

Rozzano Milan, Italy

1

, D. Franceschini

1

, A. Fogliata

1

, C.S. Iftode

1

, E.

Villa

1

, A.M. Ascolese

1

, P. Navarria

1

, C. Franzese

1

, T. Comito

1

,

A. Tozzi

1

, E. Clerici

1

, R.L.E. Liardo

1

, F. Lobefalo

1

, G.R.

D'Agostino

1

, M. Scorsetti

1

Purpose or Objective:

To report 2-years toxicity and clinical

results of hypofractionated simultaneous integrated boost

(SIB) tecnique with Volumetric Modulated Arc Therapy

(VMAT) as adjuvant treatment after breast-conserving

surgery.

Material and Methods:

Patients presenting early-stage breast

cancer were enrolled in a phase II trial. Eligibility criteria:

age>18 years, invasive cancer or DCIS, Stage I-II (T<3 cm and

N≤3), breast-conserving surgery without oncoplastic

reconstruction, any systemic therapy was allowed in

neoadjuvant or adjuvant setting. All patients underwent

VMAT-SIB technique to irradiate the whole breast and the

tumor bed. Doses to whole breast and surgical bed were

40.5Gy and 48Gy, respectively, delivered in 15 fractions over

3 weeks. Acute and late skin toxicities were recorded based

on RTOG scoring criteria and CTCAE v. 4.0, respectively.

Cosmetic outcome was assessed as excellent/good or

fair/poor, according to the Harvard scale.

Results:

The present study focused on long-term results of a

cohort of 144 patients with a minimum follow-up of 24

months (median 37, range 24-55 months). Median age was 62

y.o. (range 30-88). At one year, the highest reported skin

toxicity was G1, in 14% of the patients; this data dropped to

4% at the last follow-up, after more than 2 years. Breast pain

was recorded in 21.6% of the patients 6 months after

treatment, while it was present in 3.5% of the patients at the

last follow-up, showing a significant improvement with time.

No correlation with liponecrosis as recorded from ultrasound

exam, nor with dosimetric data. Skin toxicity was correlated

with breast volume. No pulmonary or cardiological toxicities

were recorded. After an early evaluation of clinical

outcomes, only one case presented disease relapse, as liver

metastases.

Conclusion:

The hypofractionated VMAT-SIB course as

adjuvant treatment after breast-conserving surgery showed

to be safe and effective with optimal local control. This

approach requires validation with long-term follow-up data.

EP-1169

The effect of escalating boost dose in breast cancer

patients with involved resection margin

S. Park

1

Asan Medical Center, Radiation oncology, Seoul, Korea

1

, S.D. Ahn

1

Purpose or Objective:

To investigate the impact of the boost

dose escalation on ipsilateral breast tumor recurrence (IBTR),

for breast cancer patients with involved surgical margins

after breast conserving surgery.

Material and Methods:

Between January 1998 and December

2010 at Asan Medical center, among 4275 breast cancer

patients who were treated with breast conserving therapy

(BCT), a total 192 patients were treated with boost dose over

10 Gy for involved resection margin. We retrospectively

analyzed the outcomes in 192 patients who had whole breast

irradiation of 50.4 Gy followed by median boost dose 15.0 Gy

(range, 12 - 16 Gy) for breast cancer with involved resection

margin. Surgery preceded referral for radiotherapy with a 1-2

mm margin of macroscopically normal tissue. The resection

margins were evaluated by pathologist for the presence of

invasive carcinoma or ductal carcinoma in situ at the inked

margin. Neoadjuvant chemotherapy was done in 3 patients

(1.6 %). Adjuvant chemotherapy was given in 93 patients

(48.4%). 157 patients (81.8%) received systemic hormone

therapy. The median age was 46 years (range, 25-73 years).

182 patients (94.8%) were stage 0 to II and 10 patients (5.2%)

with stage III breast cancer were also included. The boost

dose delivered with electrons or tangential fields given in

daily fractions of 1.5 to 2.5 Gy. The boost volume was

described as the site of the primary tumor with a margin of

1.5 cm to the field borders after breast conserving surgery.

Results:

The median follow-up duration for all patients was

6.7 years. IBTR were considered as any local failures on

ipsilateral breast regardless of the location. The 5-year

cumulative risk of ipsilateral breast tumor recurrence as a

first event was 5.4%. The 5-year local relapse free survival

(LRFS) was 94.4%. IBTR occurred as a first failure in 13 of 192

patients. In boost field recurrences were found in 11 patients

(85%). 5 patients (39 %) were out-of boost field failures and 3

of them were both failures. On univariate analysis, age, cell

type, pT stage, pN stage, extensive intraductal component

(EIC), multiplicity and location of resection margin were

prognostic factor for IBTR (p <0.05). In multivariate analysis

only young age (<40 years old) and positive radial resection

margin were unfavorable prognostic factor for LRFS (p

=0.037, p=0.021 respectively). pT stage was marginally

significant prognostic factor for IBTR. (p=0.088)

Conclusion:

Median boost dose of 15 Gy is comparable to

historical boost research results for local control in breast

cancer patients with involved resection margin after BCT.

Young age (<40 years old) and positive radial resection

margin rather than superficial or deep margin were important

risk factors for ipsilateral breast tumor recurrence. More than

80% of local recurrences were in boost field, more boost dose

escalation needs to be considered.

EP-1170

Onset of fatigue during and after radiotherapy in breast

cancer patient

M.S. Mariaquila Santoro

1

Hospital Pugliese-Ciaccio- Catanzaro Via Pio X- 88100

Catanzaro, Department of Hemato-Oncology- Operative

Unity of Radiotherapy and Radiobiology, Catanzaro, Italy

1

, M.A.M. Maria Angela Molinaro

1

, A.P.

Armando Pingitore

1

, R.M. Rosa. Molè

1

, A.C. Angelo Chirillo

1

,

M.L. Marianna Lacaria

1

, L.R.F. Lucia Rachele Fabiano

1

, V.M.

Vita Margheriti

1

, D.P. Domenicantonio Pingitore

1

Purpose or Objective:

Cancer-related fatigue is one of most

prevalent symptom among women submitted to radiotherapy

(RT) for breast cancer (BC). Despite its prevalence the

mechanism of onset is unknown still: one possible mechanism

is activation of the immune system, through the mediation by

proinflammatory cytokines interleukin (IL), IL1-b,

,

IL-6, and

tumor necrosis factor-

a

(TNF

-a)

as host response to tissue

damage determined by the radiant treatment. To purpose of

this study was to determine the level of fatigue in a group of

BC patients its relation to anxiety, depression, serum

cytokines, cortisol and blood count levels

Material and Methods:

Between October 2013 and May 2015

twenty-eight patients who received adjuvant RT after breast

conserving surgery were studied. The patients' subjective

feeling of fatigue intensity was measured according to with

two standardized self-assessment instruments the Fatigue

Assessment Questionnaire (FAQ) and a visual analog scale

(VAS) on fatigue intensity before the start and weekly during

RT, as well as 14 days and 3-6 and 12 months after RT. In

addition, a differential blood cell count and the serum levels

of the cytokines- IL1-b,

,

IL-6, and TNF

-a,

were determined in

parallel to the fatigue assessments.